Department of Neurology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, Wisconsin 53226, USA.
Muscle Nerve. 2010 Jul;42(1):62-9. doi: 10.1002/mus.21639.
In suspected vasculitic neuropathy, vasculitis is demonstrated in only 30% of superficial peroneal nerve (SPN)/peroneus brevis muscle (PBM) specimens. Pathologic predictors of vasculitis are thus needed for non-diagnostic cases. Immune deposits in epineurial vessels have an established sensitivity but unknown specificity. In this study we assessed specificity using direct immunofluorescence (DIF) in SPN/PBM biopsies for suspected vasculitic neuropathy. Biopsies from 13 patients with vasculitis, 13 without vasculitis, and 6 with diabetic radiculoplexus neuropathy (DRPN) were stained for immunoglobulin G (IgG), IgM, and complement 3 (C3), and analyzed in a blinded manner. Vascular immunoglobulin or C3 deposits occurred in 12 of 13 nerve or muscle biopsies (11 of 13 nerves, 5 of 13 muscles) in vasculitis vs. 1 of 13 (1 of 13 nerves, 0 of 13 muscles) in controls (P = 0.00003). Specificity was 92%. For DRPN, vascular immune deposits occurred in 5 of 6 nerves or muscles (4 of 6 nerves, 1 of 5 muscles), similar to vasculitis but significantly different from controls. Epineurial/perimysial vascular deposits of immunoglobulin/C3 by DIF are a specific marker of vasculitic neuropathy.
在疑似血管炎性神经病中，仅在 30%的腓浅神经（SPN）/腓骨短肌（PBM）标本中发现血管炎。因此，对于非诊断性病例，需要有预测血管炎的病理指标。神经外膜血管中的免疫沉积物具有既定的敏感性，但特异性未知。在这项研究中，我们评估了直接免疫荧光（DIF）在疑似血管炎性神经病的 SPN/PBM 活检中的特异性。对 13 例血管炎患者、13 例无血管炎患者和 6 例糖尿病性神经根神经病（DRPN）患者的活检进行了 IgG、IgM 和补体 3（C3）染色，并进行了盲法分析。血管免疫球蛋白或 C3 沉积物在 13 例神经或肌肉活检中的 12 例（13 例神经中的 11 例，13 例肌肉中的 5 例）中发生，而在对照组的 13 例中仅 1 例（13 例神经中的 1 例，13 例肌肉中的 0 例）发生（P = 0.00003）。特异性为 92%。对于 DRPN，血管免疫沉积物在 6 例神经或肌肉中的 5 例（6 例神经中的 4 例，5 例肌肉中的 1 例）中发生，与血管炎相似，但与对照组明显不同。DIF 显示的神经外膜/肌周血管免疫球蛋白/C3 沉积物是血管炎性神经病的特异性标志物。
